General Population Risk Individuals (Green)
In the case of a patient concerned about their risk of ovarian cancer, discuss with your patient that there is a 1% lifetime risk of developing ovarian cancer. This means that if only one relative has been affected by ovarian cancer then the patient’s risk is unlikely to be significantly raised above that of the general population. Make the patient aware that their risk may change, should a relative be diagnosed with either breast or ovarian cancer in the future.
If this is the case you would like to see them again for reassessment.
An individual’s risk of developing cancer is due to a combination of their age, genes, environmental and lifestyle factors. Examples include early age at first menses, age at childbirth, ethnicity, ovarian irradiation, contraception, HRT, diet, weight and exercise. Some of these factors may be amenable to change, for example adopting a healthier lifestyle including: avoiding obesity, avoiding excess alcohol intake and eating a healthy diet.
Moderate and High Risk Individuals (Amber)
Discuss with your patient that their risk of developing a familial cancer may be raised and this needs further assessment. At this stage it may not be possible to know whether your patient is at moderate, high or very high risk, but there may be some pointers in the history.
The level of detail that an individual clinician may want to discuss these areas with a patient will depend on the clinician’s knowledge. You may want to discuss some of the following issues:
- Patients with many affected family members with the same or related cancers which develop at a young age are more likely to have an inherited predisposition, for example in one of the dominantly inherited faulty breast/ovarian cancer genes (BRCA1, BRCA2). These patients will be in the high risk category for developing breast cancer (>30% lifetime risk) but having a faulty gene does not automatically mean that the woman will develop breast cancer.
- Patients who fall into the moderately raised risk category are unlikely to have inherited a faulty dominant cancer gene and are much more likely to have inherited some polygenic increased susceptibility, combined with environmental and lifestyle factors.
